Long-term outcomes associated with short-term surgical missions treating complex head and neck disfigurement in Ethiopia: A retrospective cohort study

Honeyman, Calum; Patel, Vinod; Yonis, E.; Fell, Matthew; Demissie, Yohannes; Eshete, Mekonen; Martin, Deborah A.; McGurk, Mark

doi:10.1016/j.bjps.2019.12.009

Cited by 10 publications

(19 citation statements)

References 12 publications

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“…Prior to the outbreak of COVID-19, follow-up after patient discharge from international surgical collaborations in Africa was challenging [ 12 ]. This study reiterates many of the traditionally cited barriers to achieving consistent patient follow-up, including financial limitations for patients, significant distances that patients are required to travel and an inability to contact patients after they are discharged due to lack of mobile phones coverage.…”

Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 pandemic on international reconstructive collaborations in Africa

et al. 2021

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Background The SARS-CoV-2 (COVID-19) pandemic has catalysed a widespread humanitarian crisis in many low- and middle-income countries around the world, with many African nations significantly impacted. The aim of this study was to quantify the impact of the COVID-19 pandemic on the planning and provision of international reconstructive collaborations in Africa. Methods An anonymous, 14-question, multiple choice questionnaire was sent to 27 non-governmental organisations who regularly perform reconstructive surgery in Africa. The survey was open to responses for four weeks, closing on the 7 th of March 2021. A single reminder was sent out at 2 weeks. The survey covered four key domains: (1) NGO demographics; (2) the impact of COVID-19 on patient follow-up; (3) barriers to the safe provision of international surgical collaborations during COVID-19; (4) the impact of COVID-19 on NGO funding. Results A total of ten reconstructive NGOs completed the survey (response rate, 37%). Ethiopia ( n = 5) and Tanzania ( n = 4) were the countries where most collaborations took place. Plastic, reconstructive and burns surgery was the most common sub-speciality ( n = 7). For NGOs that did not have a year-round presence in country ( n = 8), only one NGO was able to perform reconstructive surgery in Africa during the pandemic. The most common barrier identified was travel restrictions (within country, n = 8 or country entry-exit, n = 7). Pre-pandemic, 1547 to ≥ 1800 patients received reconstructive surgery on international surgical collaborations. After the outbreak, 70% of NGOs surveyed had treated no patients, with approximately 1405 to ≥ 1640 patients left untreated over the last year. Conclusions The COVID-19 pandemic has placed huge pressures on health services and their delivery across the globe. This theme has extended into international surgical collaborations leading to increased unmet surgical needs in low- and middle-income countries. Level of evidence: Not gradable. Supplementary Information The online version contains supplementary material available at 10.1007/s00238-021-01892-4.

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Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 pandemic on international reconstructive collaborations in Africa

et al. 2021

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“…Twenty-nine studies were case series, 4 of them were prospective, [12][13][14][15] 25 were retrospective. Two publications had at least two cohorts, [16][17][18] two were retrospective Open access cohort studies and one was a prospectively designed cohort study. 17 The overall quality of the studies was low.…”

Section: Details Of the Studiesmentioning

confidence: 99%

“…17 The overall quality of the studies was low. Three publications [16][17][18][19] were graded with an evidence level III according to the Oxford CEBM. The remaining 28 studies were retrospective case series graded as level IV.…”

Section: Details Of the Studiesmentioning

confidence: 99%

Update on Noma: systematic review on classification, outcomes and follow-up of patients undergoing reconstructive surgery after Noma disease

et al. 2021

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IntroductionNoma is a significant yet neglected disease which affects some of the least developed countries in the world. The long-term benefit and safety of Noma surgical reconstructive missions have recently been under scrutiny due to a perceived lack of measurable outcomes and appropriate follow-up. This study analyses and reports on classifications, outcome measurement tools and follow-up for reconstructive surgery after Noma disease.MethodsThis systematic review was undertaken following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The three medical databases Medline, EMBASE and Web of Sciences were searched, articles published between 1 January 1983 and 15 April 2020 were included. All primary evidence on reconstructive surgery following Noma disease, reporting data on outcome after surgery, follow-up time and complications were included. Extracted data were aggregated to generate overall and population corrected mean outcomes and complication rates.ResultsOut of 1393 identified records, 31 studies including 1110 Noma patients were analysed. NOITULP and Montandon/WHO were the most commonly used classification systems. Mouth opening (MO) and complication rates were the two most often reported outcomes. Overall mean complication rate was 44%, reported by 24 studies. Postoperative MO was reported by eight publications, of which, five reported long-term outcomes (>12 months). Mean MO improved by 20 mm when compared with mean population weighted preoperative MO (7 mm). At long-term follow-up, MO decreased to 20 mm.ConclusionsStudies reporting on neglected diseases in developing countries often lack methodological rigour. Surgeons should be mindful during patient examination by using a classification system that allows to compare preoperative versus postoperative state of disease. Short-term mission surgery is a vital part of healthcare delivery to underdeveloped and poor regions. Future missions should aim at sustainable partnerships with local healthcare providers to ensure postoperative care and long-term patient-oriented follow-up. A shift towards a diagonal treatment delivery approach, whereby local surgeons and healthcare staff are educated and empowered, should be actively promoted.PROSPERO registration numberCRD42020181931.

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“…This model offers greater opportunity for thorough followup. Indeed, new methods of long-term patient follow-up after discharge are emerging that aim to improve patient safety after STSMs in LMICs (3,4).…”

Section: Introductionmentioning

confidence: 99%

Protocol for a Systematic Review of Outcomes From Microsurgical Free Tissue Transfer Performed on Short-term Surgical Missions in Low-income and Middle-income Countries

Berker

Čebron

Bradley

et al. 2021

Preprint

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Background: In many units around the world, microsurgical free tissue transfer represents the gold standard for reconstruction of significant soft tissue defects following cancer, trauma or infection. However, many reconstructive units in low-income and middle-income countries (LMICs) do not yet have access to the resources, infrastructure or training required to perform any microsurgical procedures. Long-term international collaborations have been formed with annual short-term reconstructive missions conducting microsurgery. In the first instance, these provide reconstructive surgery to those who need it. In the longer-term, they offer an opportunity for teaching and the development of sustainable local services.Methods: A PRISMA-compliant systematic review and meta-analysis will be performed. A comprehensive, predetermined search strategy will be applied to the MEDLINE and Embase electronic databases from inception to December 2020. All clinical studies presenting sufficient data on free tissue transfer performed on short-term surgical missions (STSMs) in LMICs will be eligible for inclusion. The primary outcomes are rate of free flap failure, rate of emergency return to theatre for free flap salvage and successful salvage rate. The secondary outcomes include postoperative complications and any functional or patient reported outcome measures. Screening of studies, data extraction and assessments of study quality and bias will be conducted by two authors. Individual study quality will be assessed according to the Oxford Evidence-based Medicine Scales of Evidence 2, and risk of bias using either the ‘Revised Cochrane risk of bias tool for randomized trials’ (Rob2), or the ‘Risk of bias in non-randomized studies of interventions’ (ROBINS-I) tools. Overall strength of evidence will be assessed according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.Discussion: To-date the outcomes of microsurgical procedures performed on STSMs to LMICs are largely unknown. Improved education, funding and allocation of resources are needed to support surgeons in LMICs to perform free tissue transfer. STSMs provide a vehicle for sustainable collaboration and training. Disseminating microsurgical skills could improve the care received by patients living with reconstructive pathology in LMICs, but this is poorly established. This study sets out a robust protocol for a systematic review designed to critically analyse outcomes. Systematic review registration: Submitted to PROSPERO (15/12/20 ID: 225613)

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Long-term outcomes associated with short-term surgical missions treating complex head and neck disfigurement in Ethiopia: A retrospective cohort study

Cited by 10 publications

References 12 publications

The impact of the COVID-19 pandemic on international reconstructive collaborations in Africa

The impact of the COVID-19 pandemic on international reconstructive collaborations in Africa

Update on Noma: systematic review on classification, outcomes and follow-up of patients undergoing reconstructive surgery after Noma disease

Protocol for a Systematic Review of Outcomes From Microsurgical Free Tissue Transfer Performed on Short-term Surgical Missions in Low-income and Middle-income Countries

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